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The standard fixation of an encircling belt is a permanent scleral suture. Sutures have the disadvantage that they eventually may protrude through the conjunctiva, they may cut through the sclera causing dislocation of the belt, or they may be assciated with infections. The scleral loop requires only a round knife (Teller-Messer), formed like a plate. In case of very thin (blue) sclera a suture will not hold and extra sclera need to be sutured onto the eye. However in case of a scleral loop the sclera is prepared down to the choroid leaving usually a suffient strong scleral loop to hold the band. To avoid the tip of the band to perforate the choroid when sliding behind the sclera a guide is introduced first and removed after the band is in place.
Data Types:
  • Video
Vitreous to be demonstrated requires a focused light or a light source close to the cutter tip. A diffuse light pipe must be approached to the cutter tip. A chandelier light is diffuse and in most locations to distant from the cutter tip and unsuitable to visualize vitreous. The chandelier light provides the diffuse light for the overview (safety) and an additional light should be positioned close to the cutter opening. An illuminated cutter delivers the light where it is needed and allows a free hand to indent the retinal periphery or use an additional tool (forceps) to feed membranes into the cutter. The illuminated cutter comes as a set with a chandelier light.
Data Types:
  • Video
The situation of rupture of both eye balls concerned both eyes after a bomb explosion as a criminal attack. The patient had “perception of light” in both eyes. One eye was primarily enucleated. The other eye was reconstructed as shown here. This is meant as an example of successful reconstruction in an assumingly hopeless situation and as a reason against primary enucleation at the time of emergency surgery. Since there was no ciliary body and thus permanent aqueous insufficiency the eye was filled with silicone oil permanently. It needed no retinal revision since 15 years. The temporary keratoprothesis was replaced by a corneal transplant which was available from our eye bank at the time of primary surgery. Otherwise the temporary keratoprothesis can be left in place until a donor cornea is available for up to three days.
Data Types:
  • Video
Removal of heavy silicone oil takes about 3 minutes, due to its low viscosity of a little more than 1000 cSt. The cannula is a peripheral infusion trimmed to the appropriate length. The tip should reach to about the center of the vitreous cavity, may even less. Smaller bubbles of heavy oil can be aspirated from the posterior pole by a flute needle. Inspection of the retinal periphery with indentation is recommended, because bubbles may be entangled and retained in the vitreous base.
Data Types:
  • Video
A prominent pucker-like formation in a child is diagnosed as posterior variant of primary persistent hyaloid. After vitrectomy a thick membrane can be aspirated and peeled of the macula with the cutter. Petechial hemorrhages suggest the ILM is gone with the epimacular membrane, which is confirmed by ICG staining. At the outer prominent rim of this process no further tissue can be peeled off.
Data Types:
  • Video
The vitrectomy approach is explorative, because the condition of the retina and optic disc could not be estimated preoperatively through the dense cataract. IOP was low –normal. Since the view to the fundus was at first obscured the lens was removed via a limbal approach by a vitreous cutter. Then a common three port vitrectomy approach was possible showing a fibrotic ciliary body and peripheral retina as a consequence of long standing intermediate uveitis. The choroid showed disseminated spots of atrophy also likely consequences of (granulomatous) posterior uveitis. The ILM was peeled from the macula because of macular edema, and the retina was lasered panretinally because of retinal vascular occlusion. Spectacle were adapted. The child has ambulatory vision since 5 years now and no phthisis yet.
Data Types:
  • Video
This eye originally had PVR retinal detachment in the inferior retinal periphery. It was at first treated by vitrectomy, retinectomy and standard silicone oil. After PVR recurrence under standard silicone oil typically in the inferior peripheral retina, heavy silicone oil was filled at the occasion of re-vitrectomy. The Film shows the end of the removal of heavy silicone oil and a partially detached retina, but this time in the superior retinal periphery. The vitreous base is contracted, similar to the condition before in the inferior periphery under standard silicone oil. After retinectomy and laser the eye is filled with 20% SF6 gas. The tamponading effect is here only required in the superior retinal periphery.
Data Types:
  • Video
Standard silicone oil being lighter than water can simply be removed by aspiration. The replacing water is usually entering the eye via an end-opening straight cannula. The jet of water directed towards the center of the eye often results in a central water filled cavity surrounded by an outer rim of silicone more or less adherent to the retina. Consequently the complete removal of oil is sometimes tedious and complicated. Alternatively an infusion cannula with openings to the side but near the tip dissects the silicone oil bubble from the retina and allows rapid aspiration of a coherent oil bubble.
Data Types:
  • Video
The rational for a retinectomy in the context of refractive glaucoma is the fact that the retina is the main barrier for the transition of water from the vitreous cavity to the choroid. The advantage of a retinectomy in refractive glaucoma is, that a retinal hole cannot close/heal. Thus the IOP lowering effect lasts as long as the underlying choroidal sponge is perfused. Complications are PVR retinal detachment. That is why it is advisable to reserve retinectomy to eyes only when in a stage of
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  • Video
There are few instances when either triamcinolone or fluid jet are insufficient to help detach the hyaloid. This is my only indication in vitreo-retinal surgery to use a Tano scraper. Its rough and sticky “tongue” entangles with the collagen fibres of the hyaloid and can provide the starting edge for the cutter.
Data Types:
  • Video
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